MEDICARE: TIMOTHY L HUETTNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	13048	OK

General Provider Information

NPI Number	:	1356455810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY L HUETTNER MD

Provider Business Mailing Address
First Line	:	5555 E 71ST ST STE 7100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-6550
Country	:	US
Telephone Number	:	918-491-9007
Fax Number	:	918-491-9759

Provider Business Practice Location Address
First Line	:	5555 E 71ST ST STE 7100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-6550
Country	:	US
Telephone Number	:	918-491-9007
Fax Number	:	918-491-9759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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